Histories of Sexual Health in Britain, 1918-1980
Lead Research Organisation:
University of Birmingham
Department Name: Institute of Applied Health Research
Abstract
During the twentieth century, Britain experienced several radical transformations of its sexual-health policies and services. These developments brought huge benefits and helped to break down the stigma and inequalities that impeded access to care. Yet fundamental problems remain. Compounding these problems, sexual-health services are threatened by a looming crisis of antibiotic resistance and funding cuts to Local Authorities. History has much to teach us as we face such challenges. Understanding the historical impact of clinical practices, social conditions, cultural attitudes and policy interventions enables us to recognise long-term trends and patterns. And it makes us better equipped to tackle persistent and emerging challenges in sexual-health outcomes, service delivery and service-user experiences.
I am heading an interdisciplinary project that arms us with this knowledge, tracing sexual health in Britain from the end of the First World War to the beginning of the AIDS epidemic. Today, sexual health is defined as the ability to lead a pleasurable and safe sex life and is recognised as a vital component of overall health and wellbeing. Historically, its definition was much narrower. In clinical practice, it meant combating syphilis and gonorrhoea, the principle 'venereal' diseases (VDs) preoccupying health authorities. In the public imagination, it meant remaining morally and eugenically 'fit' to ensure the future health of the race and nation. Gradually, sexual health ballooned, becoming its own clinical field and encompassing a variety of other, newly identified VDs like chlamydia as well as diverse provisions for maternal welfare and family planning.
Key to this project is Britain's state-funded VD Service. Established in 1918 and integrated into the NHS after 1948, it was a vital part of Britain's shift towards socialised medicine. Millions of patients passed through its nationwide network of clinics. Yet the entire scheme has been overlooked by all but a handful of scholars. Building on their work, we employ new methods and underused archives to push into understudied time periods, places and themes. We take inspiration from a growing collection of transnational sexual-heath histories, exploring Britain's involvement in initiatives set up by the League of Nations and, later, the WHO to understand how regional politics and culture has influenced responses to global challenges. And because the project prioritises service-user experiences, an important focus is on oral histories that we will conduct with people who accessed or staffed clinics between 1948 and 1980.
The project addresses major gaps in the history of sexual health and provides vital context for current problems. But in exploring historical sexual health, it also foregrounds a range of themes in British history. For example, the VD Service was intended to help overcome gender, class and racial inequalities in access to healthcare. Certainly, this government initiative went a long way towards correcting a variety of social injustices and endemic health challenges. But in practice, within the clinics and wider society, prejudices and stigma persisted for decades and continue even into the present. Women and the working classes continued to be viewed as 'vectors' of contagion, in need of management and surveillance. The structural violence faced historically by LGBTQ+ communities within healthcare continues today to undermine their wellbeing and health outcomes. Similarly, institutional racism continues to have a damaging impact on BAME sexual-health experiences.
With its robust research, policy and engagement programme, the project will enrich humanities and health research, build public understandings of sexual health, inform policy, augment clinical training and create more reflexive practices among health workers. In so doing, it will have long-term benefits in improved sexual-health outcomes and service-user experiences.
I am heading an interdisciplinary project that arms us with this knowledge, tracing sexual health in Britain from the end of the First World War to the beginning of the AIDS epidemic. Today, sexual health is defined as the ability to lead a pleasurable and safe sex life and is recognised as a vital component of overall health and wellbeing. Historically, its definition was much narrower. In clinical practice, it meant combating syphilis and gonorrhoea, the principle 'venereal' diseases (VDs) preoccupying health authorities. In the public imagination, it meant remaining morally and eugenically 'fit' to ensure the future health of the race and nation. Gradually, sexual health ballooned, becoming its own clinical field and encompassing a variety of other, newly identified VDs like chlamydia as well as diverse provisions for maternal welfare and family planning.
Key to this project is Britain's state-funded VD Service. Established in 1918 and integrated into the NHS after 1948, it was a vital part of Britain's shift towards socialised medicine. Millions of patients passed through its nationwide network of clinics. Yet the entire scheme has been overlooked by all but a handful of scholars. Building on their work, we employ new methods and underused archives to push into understudied time periods, places and themes. We take inspiration from a growing collection of transnational sexual-heath histories, exploring Britain's involvement in initiatives set up by the League of Nations and, later, the WHO to understand how regional politics and culture has influenced responses to global challenges. And because the project prioritises service-user experiences, an important focus is on oral histories that we will conduct with people who accessed or staffed clinics between 1948 and 1980.
The project addresses major gaps in the history of sexual health and provides vital context for current problems. But in exploring historical sexual health, it also foregrounds a range of themes in British history. For example, the VD Service was intended to help overcome gender, class and racial inequalities in access to healthcare. Certainly, this government initiative went a long way towards correcting a variety of social injustices and endemic health challenges. But in practice, within the clinics and wider society, prejudices and stigma persisted for decades and continue even into the present. Women and the working classes continued to be viewed as 'vectors' of contagion, in need of management and surveillance. The structural violence faced historically by LGBTQ+ communities within healthcare continues today to undermine their wellbeing and health outcomes. Similarly, institutional racism continues to have a damaging impact on BAME sexual-health experiences.
With its robust research, policy and engagement programme, the project will enrich humanities and health research, build public understandings of sexual health, inform policy, augment clinical training and create more reflexive practices among health workers. In so doing, it will have long-term benefits in improved sexual-health outcomes and service-user experiences.
Organisations
- University of Birmingham (Fellow, Lead Research Organisation)
- British Assoc for Sexual Health and HIV (Project Partner)
- Thackray Medical Museum (Project Partner)
- MESMAC (Project Partner)
- Royal College of Obstetricians and Gynaecologists (Project Partner)
- National Institute for Health Research (Project Partner)
Publications
Hanley A
(2022)
Histories of 'a loathsome disease': Sexual health in modern Britain
in History Compass
Hanley A
(2022)
Migration, Racism and Sexual Health in Postwar Britain
in History Workshop Journal
Hanley, A.
(2021)
Patient Voices in Britain, 1840-1948
Hanley, A.
(2021)
Patient Voices in Britain, 1840-1948
| Description | As explained in our 'Narrative Impact' statement, this award is still underway and several major outputs and collaborations are currently under development. We hope to report on the outcomes of these in future ResearchFish submissions. In the period between October 2021 and February 2023, MR/V022806/1's most significant achievements have been: (1) The creation of new datasets: In addition to the collection and synthesis of large qualitative datasets as part of the normal course of historical archival research, the project team for MR/V022806/1 have also made substantial progress on the compilation of a major new oral-history collection, 'Oral Histories of Sexual Health in Britain, 1918-1980'. The significance of this dataset for our project's academic and engagement outputs has been described in detail in 'Research Datasets, Databases & Models'. In January 2023, we completed our planned review of the pilot oral-history study (involving 6 interviews) that we completed in 2022. This review stage was an important step in reflecting on and improving our practices before beginning work on the full oral-history collection. (2) Academic publications: The project's research is being published in internationally significant journals. For example, Hanley's 2022 article in History Workshop Journal was the first detailed historical study to deal systematically with sexual healthcare in postwar Britain. Moreover, it was a groundbreaking critique of the racism and anti-immigrant rhetoric that permeated sexual-health services and created legacies of inequality that are still felt today. As we move forward with the next phase of our academic outputs, the data from 'Oral Histories of Sexual Health in Britain' is allowing us to nuance historical understandings of medical practices, policies and attitudes that are only ever hinted at in available written records. We are also better able to understand how patients, who rarely left written accounts of their experiences, navigated sexual-health services and shared tacit knowledge and advice about which clinics were safest and which needed to be avoided. (3) Collaborations and further funding for spin-off projects: As outlined elsewhere in this ResearchFish submission, we have had considerable success securing further funding to support doctoral research affiliated with MR/V022806/1, as well as spin-off projects emerging from the work completed to date. Our AHRC Midlands4Cities Collaborative Doctoral Award is enabling us to support a PhD student to produce cutting-edge scholarship based on the vast, but thus far underutilised, archives of the Whitechapel Venereal Disease Clinic. This project will not only add another rich dimension to our understanding of historical sexual health among minoritised and marginalised communities in London. It will also strengthen our collaborative relationship with Barts Health NHS Trust Archives and Museums, who hold the Whitechapel Clinic Archives and are our formal partners on the supervisory team for this studentship. Barts Health Archives is a department of one of the UK's largest NHS acute Trusts and its collections reflect the Trust's role in medical innovation and world-leading care. Their involvement is vital for the successful completion of a groundbreaking doctoral project. It will also create future opportunities for MR/V022806/1 to work with sexual-health services to develop impactful policy and engagement outputs. In 2022, building on MR/V022806/1's early archival research and Hanley's network of SRH researchers, we also developed a bid for British Academy funding (ARP22\230003) to run a four-year digital humanities project to map the UK's changing landscape of sexual and reproductive healthcare during the twentieth century. This work will strengthen and expand national and international SRH networks through which MR/V022806/1 and ARP22\230003 will both achieve impact. [To what extent were the award objectives met? Briefly explain why any key objectives were not met.] It is too early to say whether this ongoing award's core objectives have been met. However, we have met our intermediate objectives and are on-target to meet most of our final core objectives. Our intermediate objectives included: (1) Establishing MR/V022806/1's ethical framework: Between October 2021 and December 2022, we designed the project's ethics protocols and permissions, which were then approved by the University of Birmingham and the British Library. This was an essential first step in a project where we are collecting highly sensitive and often-confronting archival and oral-history data. It was especially important to have a clear ethical framework established before commencing work with oral-history participants and developing public-engagement events. In both areas of work, we are asking people to engage with subjects that may be upsetting or even traumatising. Not only are our protocols important for minimising the risks to participants. They are also important for protecting the wellbeing of the project team, who may experience distress in the course of their research. We have since submitted an amendment to our ethics protocols and permissions to ensure that our processes for participant recruitment to 'Oral Histories of Sexual Health in Britain' are inclusive of participants who have limited literacy, partial sight and limited access to forms of online communication. Our aim is to ensure that these participants have the same understanding of the project as the wider participant cohort and are fully able to engage with, and comprehend, the project's aims, work and documentation. (2) Creating opportunities for doctoral research: We have fulfilled the first phase of our commitment to appoint project-affiliated PhD students. As planned, we secured an AHRC Midlands4Cities Collaborative Doctoral Award to support a doctoral project on migrants' sexual-health challenges and experiences. (3) Publishing research findings: In addition to the publications listed in this ResearchFish submission, our project team has several further publications in development. These include a peer-reviewed article co-written with the PDRA who has now left the project. This article is based on their research conducted while working on MR/V022806/1. Another planned article is making extensive use of 'Oral Histories of Sexual Health in Britain' to understand the types of sexual-health advice available to men who had sex with men (MSM) in Britain during the decades before and immediately after the partial decriminalisation of homosexuality. (4) Setting up 'Oral Histories of Sexual Health in Britain': As outlined elsewhere in this ResearchFish submission, we have made substantial progress on the development of this collection. The challenge going forward will be to ensure that our participant cohort is as diverse and inclusive as possible. To this end, we are developing partnerships and building relationships with individuals and organisations who engaged with sexual health in the decades before the AIDS crisis. (5) Multidisciplinary academic research network: The only major objective that is currently not on-target is the creation of a multidisciplinary academic research network. Work towards this objective was paused following the PDRA's resignation from MR/V022806/1 in 2022 when they took up a permanent lectureship at another university. Their resignation meant that, for several months, Hanley ran the project single-handedly and needed to prioritise work that was already underway. This work included the continued development of 'Oral Histories of Sexual Health in Britain'. |
| Exploitation Route | The findings emerging from the first phase of MR/V022806/1 are being taken forward by Hanley though a British Academy grant (ARP22\230003). Details of this award are outlined elsewhere in this ResearchFish submission. It is too early to anticipate how the ideas, methods and findings in MR/V022806/1's publications might be taken forward and challenged by future historians and SRH researchers. But our aim is that our publications will become a foundation for their work and in so doing push the field of historical SRH research in new and exciting directions. Once finalised and deposited with the British Library, 'Oral Histories of Sexual Health in Britain' will also become a valuable resource for future generations of researchers working on SRH as well as wider aspects of historical healthcare, welfare, gender, sexuality and race and ethnicity. We are also working with project partners to develop RSE materials from our research. At the end of the project, these RSE resources will be compiled into a teaching pack and made available to schools. And, finally, the nature of our research and collected data, which focuses so heavily on the lived experiences of sexual ill-health, makes it a fruitful source of artistic inspiration and expression. In the next phase of MR/V022806/1, we are exploring how we might successfully and ethically draw on our research to collaborate with theatre and museum professionals to develop a promenade piece about living with sexual health in 1930s Britain. |
| Sectors | Communities and Social Services/Policy,Education,Healthcare,Culture, Heritage, Museums and Collections |
| Description | As explained in our 'Key Findings', this award is still underway and several major outputs and collaborations are currently under development. We hope to report on the impact of these in future ResearchFish submissions. In the period between October 2021 and February 2023, MR/V022806/1 has achieved mostly academic impact. MR/V022806/1's outputs are fundamentally reshaping what we know about sexual health in the twentieth century. These outputs are discussed elsewhere in this ResearchFish submission. But there are several areas where the project is having especially important impact. Drawing on traditional historical research methods as well as data from 'Oral Histories of Sexual Health in Britain', we are forming a new research area focused on postwar sexual health. It is an area that has previously received very little attention. But as our work on MR/V022806/1 progresses, it is becoming increasingly clear that the postwar decades had profound implications for the ways that individuals, communities, governments and health authorities responded to the emergence of HIV/AIDS in the early 1980s. It is too early to be able to measure accurately the wider impact of our award for public, private or voluntary sectors. There have been several events where we shared our research and collected verbal feedback on its impact, specially how it helped to challenge and change individuals' attitudes towards sexual health. Details of these events and their impact are provided elsewhere in this submission. Attendees reported a change in the ways that they felt about sexual health as well as fresh thoughts about how they might better manage their own sexual health in the future and engage in positive conversations about sexual health with their families, friends and communities. In further fulfilment of objective no. 5 from MR/V022806/1-'to advance public understandings of sexual health in Britain, including the experiences of those who lived with historically stigmatising, untreatable and life-limiting conditions'-we have begun working with a team of theatre and museum professionals to design a promenade performance piece based on our project research. This piece is currently in the earliest planning stages. We are co-developing an Arts Council funding bid to take this performance-based engagement project forward. We hope to be able to report on the impact of this work in future ResearchFish submissions. In fulfilment of objective no. 3 from MR/V022806/1-'to enhance the training of medical students and create more reflexive clinical practices among health workers'-we have developed teaching for history of medicine intercalation students in the College of Medical and Dental Sciences as well as students at various stages of the University of Birmingham's MBChB. Through this historically focused teaching, students are engaging with the historical context of their training and practice. They are improving their understanding of how clinical practices affect service-user experiences. And they are being encouraged to reflect on the assumptions that shape clinical decisions and interactions with patients. |
| Sector | Education,Healthcare,Culture, Heritage, Museums and Collections |
| Impact Types | Cultural,Societal |
| Description | British Academy: Academy Research Project |
| Amount | £19,860 (GBP) |
| Funding ID | ARP22\230003 |
| Organisation | The British Academy |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 04/2023 |
| End | 03/2027 |
| Description | Liberal Arts and Natural Sciences undergraduate summer studentship scheme |
| Amount | £1,500 (GBP) |
| Organisation | University of Birmingham |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 06/2022 |
| End | 08/2022 |
| Description | Midlands4Cities Collaborative Doctoral Award |
| Amount | £94,000 (GBP) |
| Organisation | Barts Health NHS Trust |
| Sector | Public |
| Country | United Kingdom |
| Start | 10/2023 |
| End | 09/2027 |
| Title | Oral Histories of Sexual Health in Britain, 1918-1980 |
| Description | As part of MR/V022806/1, Hanley (as PI) and Martin (as the new PDRA since November 2022) are developing a major new oral-history collection in partnership with the British Library and National Life Stories. The collection records stories and memories from people who worked in or accessed sexual-health services in the UK in the decades before the AIDS crisis. To date, we have recorded approximately 30 hours of interviews with former service users, consultants, nurses and contact tracers. There are a further ten hours of interviews planned and we have clear strategies for reaching out to new participants as we continue building the collection over the next 2.5 years. At the end of the project, the collection will be deposited with the British Library, where it will become a permanent, accessible resource for other researchers and non-academic stakeholders. As part of the Participation Agreement (that is signed by everyone contributing an oral history), the project team commit to holding all oral-history data securely and not sharing it with anyone, unless obligated to do so for legal purposes. This data will be used exclusively by the project team in research, publications, educational materials and public-engagement activities for the duration of the project and for a period of 2 years following deposit of the oral-history collection with the British Library. After the 2-year post-deposit period has ended, the information contained in the interviews will be made available (subject to each contributor's agreement) through the British Library. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | The collection is proving to be a significant resource for our project team. Despite its historical importance, very little is known about almost every aspect of sexual health in the decades before the AIDS crisis. Especially scarce are records of personal stories and memories. Such experiences cannot be inferred from written records and have not been the focus of previous oral-history studies. Yet they constitute an important, unique part of Britain's past. The oral histories that we are collecting are providing vital granular detail about clinical processes and practices that are only hinted at in written records. Through our analysis of the oral-history data, we are beginning to understand the motivations and beliefs that shaped the delivery of care in clinics. Moreover, the data is also allowing us to begin centring service users in our research, prioritising their experiences and perspectives on historical sexual ill-health and healthcare. The oral histories are being incorporated into peer-reviewed publications as well as public engagement resources, such as RSE resources for AS-level students in Birmingham and Leeds. |
| URL | https://www.bl.uk/national-life-stories/partnerships |
| Description | Book Launch for Patient Voices |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | As co-editor of the collection 'Patient Voices in Britain', Hanley organised a book launch, bringing together the book's contributors to speak about the ideas and research processes that underpinned their respective chapters. The event was run as a roundtable, enabling each speaker to talk about their own work and engage with the work of their fellow contributors. In adherence to government guidance at the time, the event was held online to prevent Covid transmission. There were approximately 30 attendees, including academics, students and members of the general public. The roundtable sparked numerous technical and general questions, to which the panel responded during an extended Q&A session. Feedback from the session was positive and sales of Patient Voices were boosted as a result of the launch. Patient Voices was published as part of MUP's Social Histories of Medicine series, for which Hanley sits on the editorial board. As co-editor for the book series, she was able to secure support from MUP and the Society for the Social History of Medicine (the learned society to which the series is attached) to make this the first in a number of launches for books from the series. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Insights Lecture at the Thackray Museum of Medicine |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Each year, the Thackray Museum of Medicine in Leeds runs an innovative public lecture series called Insights. The series boasts world-class speakers exploring topics that have dominated the news and public debate. Insights lectures are held in-person with an accompanying live broadcast, which is then uploaded to the Museum's YouTube channel, ensuring wide reach to a diverse audience. In February 2022, Hanley was invited to deliver a Valentines lecture on the history of venereal disease. There were approximately 90 attendees, including academics, health professionals, students and members of the general public. The lecture, which was based on pilot research for MR/V022806/1, was designed to raise public awareness about the history of sexual health in Britain and to encourage more open discussion on sexual health today. It prompted numerous technical and general questions, which Hanley was able to address during the Q&A session that followed. From verbal feedback received after the lecture, it is clear that it had a positive impact in changing people's views on sexual health and facilitating more open discussion. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://www.youtube.com/watch?v=USz4pUZTQi4&t=4209s |
| Description | Peer-reviewed contribution to Victorian Web |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | In 2022, Hanley was invited to contribute a peer-reviewed article to a new section of the online platform Victorian Web. This new section-devoted to histories of reproductive health in the nineteenth century-is an expansion of Victorian Web and is part of the 'Great Expectations Pregnancy Project', funded by the Social Sciences and Humanities Research Council of Canada. Hanley was given a broad brief for her contribution-to write about the history of pregnancy and venereal disease. This flexibility allowed her to focus on key issues that dominated medical debate in Europe and North America. First established in 1987, Victorian Web is now a charitable organisation and one of the oldest academic and scholarly websites on the internet. It presents its entries, such as Hanley's piece on pregnancy and venereal disease, as nodes in a network of complex connections. As an invited contributor to Victorian Web, Hanley was able to build connections with North America's network of scholars working on nineteenth-century histories of reproductive medicine and health. She has also been able to situate her research and writing as a 'node' within a network of scholarship produced by world-leading scholars. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://victorianweb.org/science/maternity/uvic/2.html |